Provider Demographics
NPI:1457769325
Name:AMIRALI TAHBAZ DDS LLC
Entity Type:Organization
Organization Name:AMIRALI TAHBAZ DDS LLC
Other - Org Name:LUV BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMIRALI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHBAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-526-6711
Mailing Address - Street 1:1300 E RIVERSIDE DR
Mailing Address - Street 2:APT C204
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 W PARMER LN
Practice Address - Street 2:SUITE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4604
Practice Address - Country:US
Practice Address - Phone:512-387-0097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty